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POLICY NUMBER; 6BRPG0000005359200 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 1101 96 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - MANAGERS OR LESSORS OF <br />PREMISES <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />1. Designation of Premises (Part Leased to You) <br />Premises as described in the agreement or lease <br />Ref: LaVerne Davis <br />2. Name of Person or Organization (Additional Insured): <br />The City of Santa Ana and it's officers, employees, agents and representatives <br />Rof: CP# 697 <br />Attn: Carmen Acosta <br />1825 W Civic Center <br />Effective: 06/08/13 to <br />Santa Ana, CA 92701 <br />06/08/14 <br />3. Additional Premium: None <br />(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section Il) is amended to include as an insured the person or organization shown in the Schedule <br />but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you <br />and shown in the Schedule and subject to the following additional exclusions: <br />This insurance does not apply to: <br />1. Any "occurrence" which takes place after you cease to be a tenant in that premises. <br />2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or <br />organization shown in the Schedule. <br />CG 2011 01 96 Copyright, Insurance Services Office, Inc., 1094 <br />y aV17 lk5 �C? FC7tNi <br />�i�k_ <br />�..,...„.,.... I-.t.�-i. <br />GK e <br />psslstant City Attorn Y <br />vr Page 1 of 1 <br />